Medicare & the Health Benefit Exchange


With all the changes coming out of the Affordable Care Act and the new Health Benefit Exchanges across the country, it can be difficult to stay informed and up-to-date. What has already changed and what changes are coming later? What does this mean for me? What will it mean for my family?

The Washington State Office of the Insurance Commissioner put out some FAQs related to Medicare and the Health Benefit Exchange. (Thanks to the Crisis Clinic for sharing it via their e-newsletter!) I hope the questions and answers below will help you feel more informed. If so, pass on the information to people in your life who would benefit from it!

Do I need to re-enroll in my Medicare plan through the new health insurance Exchange?
No. Medicare’s open enrollment is not part of the new health insurance Exchange. It’s for people under age 65. People with Medicare, who want to make Medicare coverage changes, should make sure they review Medicare plans and not Exchange options.

Will I lose my Medicare coverage due to health reform and the Exchange?
No. Health reform and the Exchange do not affect your Medicare coverage. You’ll still have the same benefits and security you have now with Medicare.

Do I need a new Medicare card due to health reform?
No. But some people may try to convince you otherwise. Don’t listen to them. Protect your Medicare card just like you would a credit card or your Social Security card.

Will seniors on Medicare have to buy additional insurance due to health reform?
No. Medicare is not part of the new Exchange, so you don’t need to do anything.

Will people on Medicare receive a fine for not buying a health insurance Exchange plan?
No. In fact, it’s against the law for someone who knows you have Medicare to sell you an Exchange plan.

Can I go to the Exchange and get the subsidy to help pay for any of my Medicare coverage?
No. People on Medicare are not eligible for the subsidy through the Exchange.

What should I do if someone contacts me about signing up for an Exchange plan and I’m on Medicare?

  • Do Not sign up for an Exchange plan!
  • Do Not share your Medicare number or other personal information with anyone who knocks on your door or contacts you uninvited to sell you a health plan.
  • Do try and get the person’s contact information, such as their name, company they work for, phone number and email.
  • Do report the incident to SHIBA (Statewide Health Insurance Benefits Advisors) at (800) 562-6900.

What if I’m over age 65 and don’t qualify for Medicare – can I buy a plan in the Exchange? And if so, can I get a subsidy?
If you are over 65 and aren’t eligible for Medicare (you’ve been in the U.S legally for less than 5 years), you may buy a plan in the Exchange. However, you will not receive a subsidy.

I’m about to turn age 65 in a few months and will be eligible for Medicare, should I buy a plan in the Exchange?
If you’re about to turn 65 and you currently don’t have health insurance, you can buy a health plan in the Exchange. However, when you officially enroll in Medicare, you’ll need to drop your Exchange plan. Note: Any plan you buy in the Exchange between Oct. 1 and Dec. 31, 2013, won’t take effect until Jan. 1, 2014.

Medicare enrollees can review, compare and join a 2014 plan through December 7, 2013.

Getting ready for more health care reform


Different pieces of health care reform have been implemented and many of us are preparing for more changes this fall and early in 2014. There is a lot of information out there on health care reform and these changes, and often I just feel overwhelmed by it all.

The federal government has a website that is completely dedicated to health care reform: HealthCare.gov. It has a lot of great information, including this list of steps for individuals and families.

Given that health care reform is so big and can feel overwhelming to the Average Jane as well as health professionals, I suggest taking it in small doses.

First, learn about different types of health insurance. If you live in Washington state, learn about Washington Health Plan Finder. The exchange is set to go live in October 2013. Also visit this HealthCare.gov site to learn more about basic insurance options including Medicaid and, for those not able to afford insurance coverage, access to free or reduced/low-cost services at community health clinics in your neighborhood.

Second, make a list of questions you have before it’s time to choose your health plan. This will help you be prepared when that time comes, and you’ll feel confident you’re making a choice that works best for you and your family. It’s possible not everyone in your family will end up with the same coverage, so check out eligibility for each and every family member.

Third, learn about how insurance works. This site on insurance basics can answer your questions on types of plans and network restrictions, and different kinds of policies.

Fourth, gather basic information on your household income. HealthCare.gov says that most people will qualify to get a break on costs (premium or out-of-pocket), and that we’ll need income information to find out how much we’re eligible for.

Fifth, set your budget. Find out how much you can pay for insurance and then look at plans that fit your needs and budget. When looking at options in the Washington Health Care Exchange, you will be able to access clear information about different services, benefits, and costs right there, and compare different options available to and affordable for you.

Sixth, find out about possible employer-based health plans. Even if you work at a small business, you might have access to a health insurance plan through your employer.

Seventh, explore your options. There are plans that exist now that might work for your needs and budget. Do some research to see what is available now, and what options we can expect in the near future.

Washington’s Health Care Exchange goes live in the fall. At that point, when we have questions, we’ll be able to speak to representatives at a call center or meet with a navigator or receive other forms in-person assistance. Be sure to reach out and ask questions! This is a new system for all of us.

No-cost preventive services


This morning, the Kaiser Family Foundation published a press release and new fact sheet on the preventive services that private health plans must now cover, as directed by the Affordable Care Act (health care reform). These requirements went into effect August 1, 2011.

The preventive services that private health plans and insurance companies must now cover include:

  • Routine immunizations (influenza, HPV, tetanus, hepatitis A & B, and more)
  • Screenings for conditions like cancer and high cholesterol
  • Preventive services for children and youth (behavioral and developmental assessments, iron and fluoride supplements, and screening for autism, vision impairment, lipid disorders, tuberculosis, and certain genetic diseases)
  • Preventive services for women (annual well-woman check-ups, testing for STIs and HIV, support for breastfeeding, contraception methods, and screening and counseling for domestic violence)

On top of having to provide these health and screening services, private health plans and insurance companies may not charge co-payments, deductibles or co-insurance to patients. However, these requirements do not apply to any plan that maintains “grandfathered” status – meaning that the plan must have been in existence prior to March 23, 2010 and cannot have made significant changes to the plan’s coverage.

To read about these services and their impact in-depth, please check out the Kaiser Family Foundation’s fact sheet.

This is a follow-up to our post in early August, after the Department of Health and Human Services announced that women may now receive preventive health services at no additional cost.